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TOTAL JOINT REPLACEMENT PRE-OPERATIVE EDUCATION
The Joint Replacement
WILLAMETTE VALLEY Institute MEDICAL CENTER MCMINNVILLE , OREGON
Joint Replacement Institute Program Manager
• Pre-op education
• Daily rounds
• Patient concerns
• Follow-up Phone Call
Objectives for Today • Understanding your • Pain management
procedure • How to care for • What to expect during yourself at home
your hospital stay • Role of the “coach”• Physical/occupational • Discharge planning
therapy
Occupational Therapy (OT) • Begin on Post-Op Day 1• Activities of Daily
Living (ADL’s) – Bathing– Dressing– Personal Hygiene
Assistive Devices • Reacher• Sock Aide• Long handle shoe horn • Long handle sponge
Bathroom Equipment • Tub Transfer Bench• Shower Chair• Bedside Commode• Toilet Riser
Physical Therapy • Expectations • Exercises • Car Transfers
Equipment • Front-wheeled walker
– Measuring for correct fit – Sequencing
• Cane – Stairs – Progression to
Preparing your Home 1. Chair with arm rests 2. Check chair height 3. Remove throw rugs 4. Move electrical cords in walking space 5. De-clutter space and/or rearrange furniture
Preparing your Home (cont)
6. Make sure you have a safe path from car to entrance of your home
7. Check rails for safety, install if necessary
8. Prepare frozen meals 9. Arrange for someone to care for pets,
yard & garbage
Where to obtain equipment • Local pharmacies • On-line • Friends, family, church, civic groups • Vendor closet • Lion’s Club
What to Bring to the Hospital • Loose-fitting clothes (shorts, culottes, T-shirts) • Sweatshirt or jacket • Personal care items • Any shoe or leg orthotics • Your guidebook • Your walker, reacher, sock aide, etc. • Hearing aids • Leave valuables, cash and medications at home
Transition to Home Making the discharge plan: • Patient and family • JRIO Program Manager • Surgeon • Physical & Occupational Therapists • Discharge planner (if needed)
Role of the Coach at Home • Assist with showering/in and
out of bed • Remove bandage • Medication management • Assist with exercises • Provide encouragement &
reassurance to loved one
Understanding the Procedure • Total knee replacement (TKR)
• Total hip replacement (THR)
*Goal with surgery is to lessen pain and restore function
Procedures Total Knee Replacement • Removal of damaged bone and
cartilage from your thighbone, shinbone and kneecap with insertion of an artificial joint (prosthesis)
Procedures (cont)
Total Hip Replacement: • Removal of damaged bone and
cartilage from your thighbone and hip bone with insertion of an artificial joint (prosthesis)
Preparing for Surgery Read your guidebook Fill out orange form Start pre-operative
exercises today
Pre-operative Process • Optimized for surgery • Hospitalist evaluation and Pre-op class today • Anesthesia consult with Anesthesiologist or Certified Nurse
Anesthetist • Pre-op office appointment with surgeon • It is imperative that you follow the specific instructions given
during this process. • ASK QUESTIONS!!
Surgical Preparation • Shaving: do not shave legs 1 week before surgery • CHG Cloths: 2 evenings prior to surgery • You may eat a light meal until 8 hrs before surgery
scheduled to start • DO drink water/black coffee until 3 hours
before surgery scheduled to start
For your Financial Planning • FAQ by all patients - billing • Pre-operative
– Lab work – X-ray and radiologist to read x-ray – CT scan for some TKR and revision surgeries – Hospitalist visit – Any other specialty consultations
For your Financial Planning (cont)
• Surgery and hospital stay – Surgeon – Anesthesia provider – Hospital charges
Day of Surgery • Report to Information Desk • Go up to JRIO for
preparation for surgery • Family can wait in JRIO room and surgeon will
come up after surgery. May be 3-4 hours before you see the patient.
Pre-op Nurse/Operating Room Staff • Preparation for surgery
– IV started – Antibiotic given within hour
prior to start of surgery
– Verify patient identity – Double check allergies and
site of procedure
Recovery Room…PACU • Stabilize vital signs • Assess status and patient
will move back up to Joint Replacement Institute unit when safe to do so
Preventing Post-op Complications • Blood Clots / Pulmonary Embolus
Ankle pumps, early ambulation, compression devices • Pneumonia
Incentive spirometer, cough & deep breathing
Preventing Complications (cont.) • Infection
Vital signs, inspect incision, antibiotics • Nausea and Vomiting
Medications • Constipation
Medications & frequent mobility
Anticoagulation (cont) • Aspirin 325mg x 6 weeks
• Lovenox, x 7-10 days – Daily injection – No lab tests – If no insurance, $500-$700
Pain Scale • 0 No Pain • 10 Worst Possible Pain
• >4 Discomfort prevents: - Sleeping - Conversation - Mobility
Remember… • We can’t make the pain go completely away
• We aim to manage the discomfort so that you can eat, sleep and move around • The sooner you can move around, the better
for your recovery • Use a combination of medication & activity
to help with pain
Swelling and Bruising
• Will get WORSE the weekend after your surgery
• Treat with compression, elevation and ice • Important to keep moving!
Additional Comfort Measures • Cold therapy
- Compression gel wraps
• Move, Move, Move! – Position changes – Get up and walk with staff – Ok to walk with family when cleared
by therapy staff
Patient Responsibility • Intercept the pain; ask for medication when the pain
starts to escalate to 4/10 – do not wait until 10/10.
• Ask questions; be sure you understand the pain management efforts that are in place.
• Prepare yourself to use multiple ways to manage pain
• Read handouts provided to you in advance
Private Rooms—You are a WELL patient
Post-op Activity on Surgery Day • Goal: walk 60 feet the day of surgery • Evaluation by PT if possible, if not work with
nursing • Knees – no pillow under operative knee, heels
off bed • Hips – follow all hip precautions that will be
posted in your room • Catheter removed
Post-op Day 1 • Rise and shine early—5:30 am! • Dressed and up to recliner chair for breakfast at
7:30 am • Ready to begin PT/OT at 8:30 am • Catheter removed (if still in place) & IV capped
Group Therapy • Group exercise in activity room • 10:00am &1:00 pm POD1 • 10:00 am and 1:00
remaining days if still here • Coach participation is needed!
When do I leave the hospital? • Generally patients leave after group PT
– 11:00am or 2:00pm – Have transportation ready
Caring for Yourself at Home • Change positions and walk often • Follow your joint precautions • Walk daily and steadily; gradually increase your
distance • Perform your home exercise program 2x/day
Nutrition
• Pre-surgery: • Increase protein intake, emphasize fruits, vegetables
and liquids. • You DO NOT want to be constipated going in to
surgery • Limit coffee and alcohol
Nutrition (cont)
• Post-surgery: Eat small, low-fat meals throughout the day
• Increase your protein intake • Fiber: prunes, prune juice, figs, apricots, berries,
vegetables, legumes and whole grains
Nutrition (cont)
• Water: drink at least 8 8 oz glasses per day unless you have been instructed to restrict water. • Herbs: Echinacea, Ephedra, Garlic, Gingko,
Ginseng, kava, St. John’s Wort and Valerian can have a negative effect when mixed with other drugs and may limit incisional healing
Nutrition (cont)
• Probiotics • Acidophilus and Bifida before and after
surgery as directed on label. Important for digestive system function when antibiotics are used.
Reunion Luncheon
• Postcard Invitation • 2-3 months after surgery • Provide feedback, reunite
with staff and other patients
WITH YOUR SURGERY!
THANK YOU FOR COMING
The Joint Replacement InstituteWILLAMETTE VALLEY
MEDICAL CENTER MC M I N NVILL E, OR EGON
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